From the FDA Drug Label
Furosemide Injection, USP 10 mg/mL is a sterile, non-pyrogenic solution in vials for intravenous and intramuscular injection. The fluid used for postobstructive diuretics from hydronephrosis is 0.9% Sodium Chloride (normal saline) or 5% Dextrose in Water, but the specific fluid is not mentioned in the provided drug label.
- The label mentions Sodium Chloride for isotonicity and Water for Injection as components of the Furosemide Injection, but this does not directly answer the question.
- The label does not provide information on the type of fluid to be used for postobstructive diuretics from hydronephrosis. 1
From the Research
For postobstructive diuresis following hydronephrosis, normal saline (0.9% sodium chloride) is the recommended intravenous fluid. This approach is based on the principle of replacing volume losses to prevent dehydration while allowing the natural diuresis to proceed, as the kidneys excrete the excess fluid and solutes accumulated during the obstruction period 2. The goal is to maintain euvolemia, and careful monitoring of electrolytes (particularly sodium, potassium, and calcium) is essential, with replacement as needed based on serum levels.
Key Considerations
- Patients should receive volume replacement matching their urine output plus their insensible losses (approximately 500-1000 mL/day) 3.
- Fluid management should be adjusted based on frequent assessments of vital signs, weight, urine output, and electrolyte levels until the diuresis resolves, typically within 24-72 hours.
- The diuresis occurs because during obstruction, the kidneys lose their concentrating ability and accumulate osmotically active solutes, leading to increased urine output once the obstruction is relieved 4.
- Monitoring for potential complications such as dehydration, electrolyte imbalances, and acute kidney injury is crucial, as highlighted in the management of hydronephrosis and postobstructive diuresis 5, 6.
Management Approach
- The use of normal saline as the intravenous fluid of choice is supported by its isotonic nature, which helps maintain euvolemia without causing rapid shifts in electrolyte balance.
- The approach to fluid management should be individualized based on the patient's clinical status, urine output, and electrolyte levels, with adjustments made as necessary to prevent complications.
- While the provided evidence does not directly address the use of other intravenous fluids, the principle of maintaining euvolemia and preventing electrolyte imbalances guides the choice of normal saline as the preferred option.